According to the Medical Schemes Act, Prescribed Minimum Benefits (PMB) are a set of defined benefits that all registered medical schemes in South Africa must provide for all their members. All members have access to these benefits, no matter which plan type they are on. PMBs ensure that all medical scheme members have access to a defined list of conditions for continuous care to improve their health.
UKZN Medical Scheme plan is structured so that cover is maximised. Your health plan benefits offer more cover than just minimum requirements for PMB. Always consult your Benefit Brochure to see how you are covered.
What is a Prescribed Minimum Benefit (PMB)?
PMBs are guided by a list of medical conditions as defined in the Medical Schemes Act. According to this, all medical schemes have to cover diagnosis, treatment and care costs related to:
What must happen for me to access PMB benefits?
There are certain requirements to meet before you can benefit from PMBs. These are:
Your condition must qualify for cover and be on the list of defined PMB conditions
You should send the Scheme the results of your medical tests that confirm the diagnosis of your condition. This will allow us to identify that your condition qualifies for the treatment. Your doctor must provide the correct documentation for us, confirming the diagnosis.
For more information on where to send completed application forms see the Guide to PMBs .
Your treatment must match those in the defined benefits on the PMB list
There are standard treatments, procedures, investigations and consultations for each PMB condition on the list outlined by the Medical Schemes Act. These defined benefits are supported by thoroughly researched and evidence-based treatment guidelines.
You must use our Designated Service Providers (DSPs) for full cover
Unless there is no DSP applicable to your plan, you must use our DSPs. If you do not use a DSP, we will pay up to the scheme rate and you will be responsible for the difference between what we pay and the actual cost of your treatment. This does not apply in emergencies though. In an emergency, you can go directly to hospital and notify the scheme of your admission as soon as possible. In the case of an emergency, you are covered in full for the first 24hrs or until you are stable enough to be transferred to a DSP. Remember, benefits not included in the PMBs are paid for from available plan benefits, where appropriate and according to the rules of your health plan.
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